Build an AI billing agent that watches every claim to the posted payment
Connect your billing system and your clearinghouse to Keragon. The agent reconciles charges, follows claim status, sorts denials, checks every remit against what was posted and hands your billing team one prioritized list with the evidence attached. It prepares the fix; your team approves it.
Your voice AI agent · the conversation
Keragon · in your systems
Illustrative call with synthetic names.
Trusted by healthcare teams across the US
The problem
Every claim nobody is watching is money that arrives late, short or never
- Claims go out, then nobody looks until the money doesn't come Status gets checked when someone has an hour for payer portals, and a stalled claim finds you at the filing deadline.
- Denials pile up with no owner and no deadline The remit lands, the codes get printed, and the appeal window closes while the claim waits in a tray.
- "Paid" hides what was never posted and what was paid short Nobody compares the remit to the posting, the deposit or the contract, so the leakage stays invisible.
What it handles
Every claim watched, from the visit to the posted payment
The agent does the checking and the chasing. Your billing team keeps every decision that moves money.
Charge reconciliation
Compares completed, signed visits with the claims in your billing system and lists every visit that never became a claim.
Claim status monitoring
Follows every open claim through your clearinghouse and flags stalls, rejections and anything close to its filing deadline.
Denial triage
Sorts each denial by the payer's reason, tells rejected from denied from underpaid, and drafts the correction or appeal with its deadline.
ERA posting reconciliation
Matches each remit to its claims, checks the posting against what the payer stated, and matches the deposit.
Underpayment detection
Compares what the payer allowed with your fee schedule and flags payments that fall short, with the contract line attached.
A/R work queue
One prioritized list for your billing team, ordered by deadline and dollars, with the evidence on every item.
shieldGuardrails
Every correction, appeal, posting fix and write-off is drafted for your biller to approve. Nothing that moves money is sent or posted on its own.
It flags a visit whose claim does not match the signed note. It never picks, changes or upgrades a billing code or a modifier.
An accepted claim, a payer's "paid" and a posted payment are three different facts. It tells you which one it has.
A denial or a balance never becomes a patient statement until your team decides. Patient responsibility is shown to you, not sent.
Connect your billing system, your clearinghouse and your team's queue to Keragon, then describe the job. The agent watches every claim and files the work where your team already looks. HIPAA-compliant, every night.
From a claim in your billing system to a worked queue, every night
Describe the job and Keragon runs it end to end, connected to your practice management system, phones, forms and messaging, HIPAA-compliant, even after hours.
How it connects
The claim starts it. The evidence lands in your queue.
Keragon reads your billing system and your clearinghouse, and writes the work back where your team already looks.
Your EHR or billing system
Keragon- Runs from your claims, not a spreadsheet
- Evidence attached to every item
- HIPAA-compliant, BAA included
Your clearinghouse
Your team and your books
The alternatives
A billing service works your claims out of sight. The agent works them in your systems.
Keep your billing system, your clearinghouse and your billing company if you have one. The agent is the pair of eyes on every claim between them, and your biller stays the one who decides.
Specialties
One billing agent, any payer mix
Session claims, dental remits, Medicare sequestration, cash-pay with the odd insured visit: the exception rules change, the agent does not.
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What should your billing agent catch first?
Pick a job or describe your own. It opens in Keragon with the agent drafted, ready to connect your billing system and your clearinghouse.
Text back a missed call and book the appointment
Text back a missed call and book the appointment
Answer an after-hours new patient call
Answer an after-hours new patient call
Turn a website form into a booked appointment
Turn a website form into a booked appointment
The actual rules
This is what "in plain English" looks like
The agent runs on instructions you can read, in your words. Here is part of a set from a practice we will call Northside.
1 · What to watch
Every claim in athenahealth from the moment it is created, and every completed visit with a signed note from the past 30 days. Skip self-pay visits and visits marked no-show.
2 · What counts as an exception
A signed visit with no claim after 5 business days. A claim with no payer response after 21 days. Any rejection or denial. A remit line that does not match the posting, or an allowed amount below the fee schedule by more than $2 or 2%.
3 · What to attach
The payer's response with its date, the remit line, the contract line from the fee schedule, and the deadline calculated from the payer's date. Plain English on top, the codes underneath.
4 · Who decides
Put every item in the billing queue ordered by deadline, then by dollars. Draft the corrected claim, the reconsideration or the posting correction, and wait. Maria approves; nothing is sent, posted or written off until she does.
5 · Never
Change a billing code or a modifier, decide what a visit should have been billed as, write off a balance, send a patient a statement, or tell anyone a claim is paid before the payment is posted.
What these rules make sure of
- Every claim, every night. The schedule decides, not whoever has an hour for portals.
- A deadline on every item. Calculated from the payer's date, visible in the queue.
- Evidence first. The remit line, the response and the contract line, attached.
- Your biller decides. Drafted and waiting. Nothing moves money on its own.
Change clearinghouses, keep every rule. The rules live in Keragon, not in your billing system.
What it is
What does an AI billing and RCM agent do?
A short definition of an AI billing and revenue cycle agent, and when it runs for your billing team.
What it does
It watches every claim after the visit. It checks that each completed, signed visit became a claim in your billing system, follows claim status through your clearinghouse, sorts every denial and rejection by the payer's reason and its deadline, matches each electronic remittance (ERA) to its claims, its posting and its deposit, compares what the payer allowed with your fee schedule, and keeps one prioritized work queue for your billing team with the evidence attached to every item. It prepares corrections, appeals and posting fixes, and a person approves them. It never changes a billing code, never writes off a balance and never bills a patient on its own. On Keragon, the claim in your EHR or billing system starts every run and the work is written back to the systems your team already uses.
When it runs
- A claim is created or changes in your billing system
- Every night, for the visits signed in the past month
- When a remit (ERA) arrives from your clearinghouse
- Weekly, for every claim with no payer response in 21 days
Learn more before you switch anything on
Guides from the Keragon library, written for healthcare operations teams.
FAQ
The questions billing teams ask first
Straight answers, before you commit to anything.
What does an AI billing and RCM agent do?
It watches every claim after the visit: it checks that each signed visit became a claim, follows claim status through your clearinghouse, sorts denials by the payer's reason and deadline, matches each electronic remittance (ERA) to its claims, its posting and its deposit, compares what the payer allowed with your fee schedule, and keeps one prioritized work queue for your billing team with the evidence attached. The checking and chasing are automatic; every decision that moves money stays with your team.
Does it change billing codes or decide what to bill?
No, and that is deliberate. It flags a visit whose claim does not match the signed note, and it never picks, changes or upgrades a code or a modifier. Coding stays with the people your practice has made responsible for it, and the agent gives them the evidence.
Does it send claims, appeals or corrections on its own?
No. It drafts the corrected claim, the reconsideration or the appeal with the evidence attached and puts it in your queue with its deadline. A person on your team approves it. Where your clearinghouse accepts the submission through Keragon, the approved claim is sent; otherwise the packet is handed to you to send, and the agent tracks it either way.
Which billing systems and clearinghouses does it work with?
Billing systems and EHRs where the claim can start the run and the work can be written back: athenahealth, AdvancedMD, Tebra, Healthie, Elation, IntakeQ, ModMed and more. Clearinghouses for status and remits: Claim.MD for electronic remittances, Office Ally EDI Services for claim status, Availity for claim submission and authorizations. The full list is at keragon.com/all-integrations.
How does it know a payment was short?
You give it your fee schedules, in a sheet or in your billing system, and it compares the allowed amount on each remit line with the contracted rate for that code, payer and date of service. A shortfall beyond the tolerance you set is flagged with the contract line attached. When no contract is loaded for a payer, it marks the variance as suspected rather than calling it an underpayment.
Does it tell a rejected claim from a denied one from an underpaid one?
Yes. A rejection never reached adjudication and needs a corrected claim. A denial was adjudicated and needs a reconsideration or an appeal by a payer deadline. An underpayment was paid, but below the contracted amount. Each gets its own route, deadline and draft, because treating them as one pile is how deadlines get missed.
Does it post payments?
It checks every posting against the remit and prepares the correction when they differ. Where your billing system supports a posting write through Keragon, such as AdvancedMD or Tebra, the approved posting is written back; otherwise it is handed to your biller. It never posts, writes off or refunds anything without approval.
Will it bill my patients?
No. Patient responsibility from the remit is shown to your team on the queue item. Whether and when a statement goes out stays your decision, and patient outreach is a separate agent on the patient communication page.
Is it HIPAA-compliant, and do we get a BAA?
Yes. Keragon is HIPAA-compliant and SOC 2 Type II audited, with a BAA included on every paid plan. Claim and remit data moves through your clearinghouse and billing system under their own agreements, and the work lands in your own systems.
What does it cost?
Plans are public at keragon.com/pricing, and every plan starts with a 14-day free trial, no credit card. The agent runs as part of your Keragon plan; there are no per-claim fees from Keragon. Your clearinghouse's own transaction pricing is yours, directly with them.
We use a billing company. Does this replace them?
No. It gives you and your billing company the same queue: every claim watched, every exception with its evidence and deadline, in your systems rather than theirs. Your billing company keeps working the claims; you can finally see what was done and what is still open.
How fast can we go live?
Same day for most practices. Describe the job in plain English, connect your billing system and your clearinghouse, set the thresholds, run it against last month's claims on test data, read what it would have flagged, and switch it on for tonight's run.
Built for healthcare billing teams
Every claim watched. Every dollar explained.
Your billing team keeps every decision that moves money. Your AI billing and RCM agent can be live today.
14-day free trial · no credit card · cancel anytime
